Provider Demographics
NPI:1740286368
Name:BALLESTEROS, RUBEN F (MD)
Entity type:Individual
Prefix:DR
First Name:RUBEN
Middle Name:F
Last Name:BALLESTEROS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7401 OSLER DR
Mailing Address - Street 2:STE 208
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21204-7622
Mailing Address - Country:US
Mailing Address - Phone:410-823-3885
Mailing Address - Fax:410-823-6888
Practice Address - Street 1:7401 OSLER DR
Practice Address - Street 2:STE 208
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21204-7622
Practice Address - Country:US
Practice Address - Phone:410-823-3885
Practice Address - Fax:410-823-6888
Is Sole Proprietor?:No
Enumeration Date:2005-06-28
Last Update Date:2014-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0015194246ZS0410X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Technologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD30218001OtherCAREFIRST BLUE SHIELD
MD520913207OtherCORP. TAX ID
MD520913207OtherCORP. TAX ID
MD231L335BMedicare ID - Type Unspecified